Treatment of PCOS

Bozena Bidzinska-Speichert

Polycystic ovary syndrome (PCOS) is a extremely common endocrinopathy, occurring in 57 percent of women in reproductive age. PCOS, a hyperandrogenic disorder, is the most common cause of infertility in women. The diagnosis of PCOS has life-long implications with increased risk for infertility, metabolic syndrome, diabetes mellitus type 2, and possibly cardiovascular disease. The recent criteria outlined in the EHSHRE/ARM consensus statement (Rotterdam criteria) have been proposed to make the diagnosis of PCOS (two out of three of the following criteria): oligo- and/or anovulation, clinical and/or biochemical signs of hyperandrogenism, polycystic ovaries (by ultrasound). Other causes of hyperandrogenism, such as an androgen secreting ovarian tumor, hyperprolactinemia, or NC CAH, should be excluded. Polycystic ovary syndrome (PCOS) must be suspected in every adolescent girl with menstrual irregularity, hirsutism, obesity, persistent acne vulgaris, scalp hair loss and hyperhidrosis. Treatment for PCOS is still as controversial as difficult: oral contraceptive pill OCP (increasing concentrations of SHBG while decreasing androgen secretion, it reduces FAI), spironolactone and drospirenone, an analogue of spironolactone, progestin, cyproterone acetate, glucocorticoid therapy (beneficial in the treatment of menstrual irregularity in the minority of nonobese PCOS with a strong component of FAH), GnRH agonist therapy, flutamide/nilutamide (specific but hepatotoxic antiandrogen with efficacy similar to that of cyproterone), finasteride (a type 1 5-alpha-reductase inhibitor), metformin (improving insulin sensitivity, suppressing appetite and enhancing weight loss, promoting ovulation) and thiazolidinediones (?). Weight loss and every treatment reducing insulin resistance in both obese and lean women with PCOS may have beneficial results causing a fall in ovarian androgen secretion and an improvement in pituitary-ovarian axis, which may have impact on hair growth, menstrual regularity and fertility. Physical hair removal to mask the presence of excess hair are basic to treat hirsutism: chemical depilitating agents, bleaching, waxing techniques, laser therapy and electrolysis.